One year ago, Minnesotans had recently endured the state’s first big wave of COVID-19 hospitalizations and deaths. Shots had just been made available to people over 65, but less than 10 percent of the state’s population had received a first dose.
When data were released that showed who those first vaccinations were going to, they revealed stark disparities by race and ethnicity, with eligible Minnesotans identifying as white more likely to have been vaccinated than Minnesotans of other races and ethnicities.
A year into the vaccine roll out, things are looking better, with most racial and ethnic gaps in vaccination slowly closing, but experts say there is still much work to do.
Vaccination rates improve
As of this week, 73.6 percent of Minnesotans age 5 and older have received at least one dose of a COVID-19 vaccine against COVID-19.
As far as what the rates look like by race and ethnicity, data from the Minnesota Department of Health show Minnesotans identifying as Asian and Pacific Islander have, by far, the highest rate of vaccination. That’s followed by white Minnesotans.
A disparity in vaccination rates in Minnesota’s white and Hispanic and Black populations has shrunk, gaps remain. Meanwhile, bigger gaps persist between white Minnesotans and American Indian and multiracial Minnesotans.
Looking at vaccination rates by age group complicates the picture. For people over 65, vaccination rates are higher regardless of race. But for younger age groups, vaccination rates vary more. And because some racial or ethnic groups have more young people overall, this can have a big influence on the overall vaccination rate for that group.
Vaccination disparities are important because they figure into overall health outcomes from the pandemic. Data from the Minnesota Department of Health show Minnesotans who are Black/African American, Asian, Indigenous, Hispanic and multiracial-identifying have higher rates of COVID-19 hospitalization and death than white Minnesotans.
There are further disparities within racial and ethnic groups based on whether people were born in the U.S. or elsewhere. A paper published earlier this month by researchers at the University of Minnesota looked at disparities in COVID-19 deaths in 2020 based on whether people’s death certificates said they were born in the U.S. or outside of it. It found that foreign-born Minnesotans died of COVID-19 at twice the rate of Minnesotans born in the U.S.
“This is the most serious outcome of the pandemic. Who is dying is what is defining the disparities in the ultimate outcomes of the pandemic,” said Kimberly Horner, a doctoral student at Humphrey School of Public Affairs and author of the paper. The findings underscore that disparities likely exist at many levels — from how likely people are to be exposed to the virus to how likely they are to die of it.
Nationally, the picture looks similar to Minnesota, with vaccination gaps narrowing over time, but still persistent.
“A year out, what we have seen is that vaccine inequities have diminished over the past year, with the gap for Hispanic and white people almost closing and the gap between white and Black people getting narrower,” said Nambi Ndugga, a policy analyst with the Racial Equity and Health Policy team at the Kaiser Family Foundation.
Last April, when vaccines were beginning to become more widely available, there was a 14 percentage point gap in the share of white people and eligible Black people who had been vaccinated. Now, the gap is 6 percentage points — still a gap, but smaller.
When it comes to the white-Hispanic vaccine gap, it was 13 percentage points last April and is now nearly eliminated. Other gaps remain, too.
Meeting people where they are
Dr. Nathan Chomilo, senior equity advisor to the MDH commissioner, said Minnesota has come a long way on vaccine equity in the last year.
“I’d say, grade us on the curve, the curve being other states in the U.S., I think we look pretty good,” he said, crediting a suite of programs launched through the state health department that reached people with information about vaccines and made vaccines accessible on many different fronts, as well as an emphasis on data collection.
Some of the equity initiatives include using community-based organizations that could provide information about the vaccines as well and how to get them. The department also partnered with diverse media organizations to get the message out on vaccines across many channels. A “Shots at the Shop” program brought vaccines to barber shops and salons. Outreach through trusted messengers got information and vaccines to hard-to-reach unhoused populations, and mobile vaccine clinics made vaccines more readily available to many communities. As of November, the department had hosted more than a thousand community vaccination sites in partnership with community groups.
Chomilo said he hopes the community-based aspects of COVID-19 vaccination outreach serve as a model for public health moving forward.
“It really just integrates and centers community voices, it helps work with them to get messages out through trusted messengers, it helps hear where the needs are so we could focus resources more accurately and reliably,” he said.
The efforts by MDH acknowledge that being able to get a vaccine is only one part of the picture when it comes to vaccine disparities.
While we have reached a point where most communities have physical access to a vaccine, different communities have different experiences with marginalization and oppression that mean they have different needs, said Rachel Hardeman, director of the University of Minnesota’s Center for Antiracism Research for Health Equity.
“It’s important to understand that access is bigger than just, ‘is there a vaccine available in this community, in the city, in the state?’ Access isn’t just about where in my community can I get the vaccine, it’s also about ‘Do I have the right knowledge about its safety, its efficacy, why it’s important? Do I have access to a trusted provider clinician, or administrator of the vaccine?’”
One lesson Hardeman said she hopes we have learned from the vaccine rollout is that using one lens to look at something like COVID-19 vulnerability might be missing the bigger picture from an equity perspective.
For example: Early on in the vaccine rollout, Minnesota prioritized vaccination for Minnesotans age 65 and older, a group at high risk of complications from the virus. But older Minnesotans weren’t the only group at higher risk of complications from COVID-19. Data show Minnesota’s populations of color that skew younger, on average were being hospitalized and dying at higher rates than white Minnesotans.
“So by focusing on vaccine access and allocation to a population that’s older than 65, we’re missing people of color in the state. We miss people of color in the state who are under the age of 65, but disproportionately burdened by exposure and severity too,” Hardeman said.
On the front lines
Inari Mohammed, an epidemiology doctoral student at the University of Minnesota, volunteers with the Seward Vaccine Equity Project, a group that’s been holding vaccine clinics in the Seward area. Mohammed was prompted to volunteer because, she said, as a person who is part of the Oromo community and studies health inequity, she knows how important it is to meet people where they are at with vaccines, addressing barriers big and small.
At a recent vaccination event she helped organize at her mosque, the Tawfiq Islamic Center in Seward, about 60 people received COVID-19 vaccinations. For many, their first dose.
“We were able to give people rides, have people there who were able to translate or interpret, we had the mosque really be super supportive,” she said. “I think that gave people confidence, seeing that their faith leaders were in favor of the vaccine made people comfortable and increased confidence in the vaccine.”
Ultimately, equity means that resources are allocated so that everyone has the opportunity to attain their highest level of health, Hardeman said. “What we know, and what COVID has shown us is that not everyone is on the same playing field when it comes to their health and well-being, which means some communities, some people, some populations are going to need more and others may need less.” That means if resources are distributed generally, without equity considerations, the gap never closes.
Hardeman said the conversation — and the action — needs to continue.
“With this omicron surge, the conversation has been around the importance of booster shots, so this isn’t going away. And so I think that because of that, we have to continue to talk about equity and lead with equity. It’s not just about the initial rollout.”